Serologic Antibody Patterns

	No Infection-	Primary Acute Infection-	Established Infection---	Convalescence-----	Past (remote) Infection--
Heterophile Ab----- (monospot)))	–	+	+	Decreasing	–
VCA-IgM (viral capsid antigen)	0 or <1:10	+ >1:10	+ or >1:10	Decreasing	0 or ≤1:10
VCA-IgG (viral capsid antigen)	0 or <1:10	– (+ early)	+ or >1:10	Increasing	+ or ≥1:10
EA-IgM (early antigen anti-D)	–	+	+	Decreasing	–
EA-IgG (early antigen anti-D)	–	– (+ early)	+	Decreasing	+
EBNA-IgG (Epstein-Barr nuclear antigen)	0 or <1:5	0 or <1:5	0 or <1:5	Increasing	+ or ≥1:5

EBV Infection Status	-----IgM-VCA-----	-----IgG-VCA-----	-----EBNA-----	-----Anti-EA-----
No current or prior EBV infection	–	–	–	–
Acute primary EBV infection	++	++++	–	++
Recent past EBV infection (<6 mo)	+	+++	–	++
Convalescent/post-EBV infection	–	+++	+	±
Chronic or reactivation infection	±	++++	±	+++
EBV-associated malignancies	–	++++	±	+++

Note:

Acute primary EBV infection is indicated by ≥1 of these serologic findings:
- IgM-VCA that is found early and later declines
- High titer (≥1:320) or ≥4× rise in IgG-VCA titer during the illness
- Transient rise in anti-D titer (≥1:10)
- Early IgG-VCA without EBNA and later appearance of EBNA
Acute or primary EBV infection is excluded when IgG-VCA and EBNA titers are unchanged in acute and convalescent serum samples.
Current or recent infection is indicated by IgM anti-VCA or IgM/IgG early antigen with low or absent EBNA antibodies.
Persistence of early antigen and IgG-VCA in high titer indicate chronic EBV infection.

References